1.Traumatic Hemipelvectomy with Free Gluteus Maximus Fillet Flap Covers: A Case Report
WI Faisham ; WS Azman ; TMS Muzaffar ; DAJ Muslim ; AH Azhar ; MM Yahya
Malaysian Orthopaedic Journal 2012;6(2):37-39
Traumatic hemipelvectomy is an uncommon and life
threatening injury. We report a case of a 16-year-old boy
involved in a traffic accident who presented with an almost
circumferential pelvic wound with wide diastasis of the right sacroiliac joint and symphysis pubis. The injury was
associated with complete avulsion of external and internal
iliac vessels as well as the femoral and sciatic nerves. He also had ipsilateral open comminuted fractures of the femur and tibia. Emergency debridement and completion of amputation with preservation of the posterior gluteal flap and primary anastomosis of the inferior gluteal vessels to the internal iliac artery stump were performed. A free fillet flap was used to close the massive exposed area.
2.The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization
Jagdish Krishnan ; M Paiman ; AS Nawfar ; MI Yusof ; W Zulmi ; WS Azman ; AS Halim ; AZ Mat Saad ; MD Shafei ; WI Faisham
Malaysian Orthopaedic Journal 2014;8(1):14-20
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries.
The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results
Extremities
3.Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies
Tunku-Naziha TZ ; Wan-Yuhana WMS ; Hadizie D ; Muhammad-Paiman ; Abdul-Nawfar S, M ; Wan-Azman WS ; Arman-Z MS ; Abdul-Razak S ; Rhendra-Hardy MZ ; Wan-Faisham WI
Malaysian Orthopaedic Journal 2017;11(1):12-17
The management of pink pulseless limbs in supracondylar
fractures has remained controversial, especially with regards
to the indication for exploration in a clinically well-perfused
hand. We reviewed a series of seven patients who underwent
surgical exploration of the brachial artery following
supracondylar fracture. All patients had a non-palpable radial
artery, which was confirmed by Doppler ultrasound. CT
angiography revealed complete blockage of the artery with
good collateral and distal run-off. Two patients were more
complicated with peripheral nerve injuries, one median
nerve and one ulnar nerve. Only one patient had persistent
arterial constriction which required reverse saphenous graft.
The brachial arteries were found to be compressed by
fracture fragments, but were in continuity. The vessels were
patent after the release of obstruction and the stabilization of
the fracture. There was no transection of major nerves. The
radial pulse was persistently present after 12 weeks, and the
nerve activity returned to full function.
Humerus
;
Fractures, Bone
4.Long-term Outcome of Total Femur Replacement
Adzhar AL ; Faisham WI ; Zulmi W ; Azman WS ; Sahran Y ; Syurahbil AH ; Nor-Azman MZ
Malaysian Orthopaedic Journal 2023;17(No.2):21-27
Introduction: Total femur replacement is an option instead
of amputation for extensive bone tumour or after revision
surgery with a massive bone loss. Over a long period of time
the patients may need revision surgery, and this might affect
the functional outcome. We reviewed all consecutive total
femur replacements done for primary and revision surgery of
primary bone tumours in our centre to evaluate the long-term
functional outcome and survival.
Materials and methods: All patients who had total femur
resection and reconstruction with modular endoprosthesis
replacement in our centre from June 1997 to May 2022 were
reviewed. The respondents were surveyed through
WhatsApp using google form which was translated into
Bahasa Malaysia based on the Musculoskeletal Tumour
Society Scoring System (MSTS). The data were presented as
descriptive data on the final survival of the limb and
prosthesis.
Results: Ten patients underwent total femur replacement.
There were eight osteosarcoma, one giant cell tumour and
one chondromyxoid fibroma. Three patients with
osteosarcoma succumbed to pulmonary metastases; all had
good early post-operative functional outcomes without local
recurrence. Seven patients were available for long term
evaluation of function with a mean follow-up of 17.6 years
(ranged 10-25 years). Four patients with total femur
replacement had good functional outcomes (60-80%)
without revision with 10-25 years follow-up. Three patients
experienced acetabulum erosion and chronic pain that
required early hip replacements. Two of them were
complicated with superior erosions and bone loss and
subsequently were managed with massive reconstruction
using cemented acetabulum cage reconstruction. The other
has diabetes mellitus with chronic infection following
revision of distal femur endoprosthesis to total femur
replacement and subsequently underwent limited
hemipelvectomy after 14 years.
Conclusion: Total femur replacement offers a good long
term functional outcome and prosthesis survival and is a
favourable option for limb salvage surgery.
5.Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion
Choo CY ; Mat-Saad AM ; Wan-Azman WS ; Wan Z ; Nor-Azman MZ ; Yahaya S ; Faisham WI
Malaysian Orthopaedic Journal 2018;12(3):19-23
Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups.